93 Decision Citation: BVA 93-06771
Y93
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 90-44 281 ) DATE
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THE ISSUES
1. Entitlement to service connection for a right shoulder
disorder, arthritis of the left foot, cholesterolemia and a
heart disorder.
2. Entitlement to increased (compensable) ratings for
bilateral pes planus, a dysthymic disorder and bilateral
hearing loss.
REPRESENTATION
Appellant represented by: Veterans' Service Commission,
Maryland
ATTORNEY FOR THE BOARD
Brian J. Milmoe, Counsel
INTRODUCTION
This matter was most recently before the Board of Veterans'
Appeals (BVA) in May 1991, at which time it was remanded to
the Baltimore, Maryland, regional office (RO) for additional
evidentiary development. The veteran served on active duty
from February 1979 to June 1989, with prior military service
totaling 11 years, 2 months and 29 days. Following the
completion of the requested development actions, additional
rating action was undertaken in September 1991, in which the
veteran's entitlement to service connection for a heart
disorder and hypercholesterolemia continued to be denied and
service connection for impotency was granted. A
supplemental statement of the case was provided to the
veteran in October 1991. By a rating action in March 1991,
the RO increased the schedular evaluation for the veteran's
service-connected peripheral vascular insufficiency of the
left lower extremity from 0 percent to 20 percent, effective
from October 1991. Although the matter of the rating to be
assigned for the veteran's peripheral vascular insufficiency
was not before BVA in May 1991 or thereafter, the assignment
of a compensable schedular evaluation for one of the
veteran's service-connected disabilities renders moot the
issue of entitlement to a compensable schedular evaluation
under 38 C.F.R. § 3.324 (1992), based on multiple
noncompensable service-connected disorders. Entered into
the record in January 1992 was a Statement of Accredited
Representative in Appealed Case. The case was again
received at BVA in March 1992 and docketed in April 1992.
The case is once again ready for appellate review.
CONTENTIONS OF APPELLANT ON APPEAL
It is contended by the veteran, in substance, that disorders
involving the right shoulder, arthritis of the left foot,
cholesterolemia and cardiomegaly had their onset during his
extended period of active duty. Allegations are advanced to
the effect that the veteran is bothered by constant pain of
the right shoulder and that his right shoulder impairment
adversely affects his ability to lift objects. Reportedly
examination and treatment reports compiled in service refer
extensively to the veteran's cholesterolemia and enlarged
heart. It is asserted by the veteran that compensable
schedular evaluations are warranted for bilateral pes
planus, as manifested by painful walking, his dysthymic
disorder, as manifested by recurrent depression and an
inability to deal with people, and bilateral hearing loss,
based on his inability to hear others. It is claimed that
medical examinations performed by the Department of Veterans
Affairs (VA) prior to 1991 were not detailed or
comprehensive evaluations.
DECISION OF THE BOARD
In accordance with the provisions of 38 U.S.C.A. § 7104
(West 1991), and upon review and consideration of all
evidence and material of record in the veteran's claims
file, and for the following reasons and bases, it is the
decision of BVA that a preponderance of the evidence is
against the veteran's claim of entitlement to service
connection for a right shoulder disorder, arthritis of the
left foot, cholesterolemia and a heart disorder, and for
increased (compensable) ratings for bilateral pes planus, a
dysthymic disorder and bilateral hearing loss.
FINDINGS OF FACT
1. All relevant evidence necessary for equitable
disposition of the veteran's appeal has been obtained by the
RO.
2. Manifestations of a right shoulder disorder are not
identified in service medical records, and the veteran's
initial complaints of right shoulder soreness in August 1989
are not shown to be related to the veteran's period of
military service or any event thereof.
3. Arthritic involvement of the left foot due to trauma,
gout or other cause is not objectively identified in service
or thereafter.
4. Service medical records identify elevated cholesterol
levels of the veteran between 1980 and 1989, but in the
absence of an identifiable disorder manifested by
cholesterolemia, the abnormal laboratory values alone are
not a disease or injury or otherwise representative of
disability for which a grant of service connection may be
made.
5. Notwithstanding the inservice presence of episodically
elevated blood pressure readings and the claimed existence
of cardiomegaly, a heart or cardiovascular disorder, to
include hypertension, is not shown either in service or
thereafter.
6. The veteran's bilateral pes planus is at present
manifested by marked depression of the longitudinal arches,
relaxation of the plantar fascia and pronation and external
rotation of the feet with mild heel valgus, but without
tenderness of the plantar surface of either foot.
7. The veteran's service-connected dysthymic disorder is
currently productive of no impairment of the veteran's
industrial adaptability.
8. Recent audiometric data show that there exist average
pure tone thresholds of 45 and 35 decibels for the right and
left ears, respectively, with 96 percent speech
discrimination ability, bilaterally.
9. An exceptional or unusual disability picture is not
shown to be associated with service-connected disabilities
involving bilateral pes planus, a dysthymic disorder or
bilateral hearing loss.
CONCLUSIONS OF LAW
1. A right shoulder disorder, arthritis of the left foot,
cholesterolemia or a heart disorder was not incurred in or
aggravated by service, nor may arthritis of the left foot or
a cardiovascular disorder, to include hypertension, be
presumed to have been incurred therein. 38 U.S.C.A.
§§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 1991);
38 C.F.R. §§ 3.303, 3.307, 3.309 (1992).
2. The schedular criteria for assignment of a 10 percent
rating, but none greater, for bilateral pes planus have been
met; extraschedular criteria for assignment of a rating in
excess of 10 percent have not been met. 38 U.S.C.A.
§§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b), 4.1, 4.2,
4.3, 4.7, 4.10, 4.40, 4.57, 4.59 and Part 4, Code 5276
(1992).
3. The schedular and extraschedular criteria for an
increased (compensable) rating for a dysthymic disorder have
not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R.
§§ 3.321(b), 4.1, 4.2, 4.3, 4.7, 4.10, 4.129, 4.130 and
Part 4, Code 9405 (1992).
4. The schedular and extraschedular criteria for an
increased (compensable) rating for bilateral hearing loss
have not been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R.
§§ 3.321(b), 4.1, 4.2, 4.3, 4.7, 4.10, 4.85, 4.87 and
Part 4, Code 6100 (1992).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
At the outset, we find that the veteran's claim for multiple
benefits is "well-grounded" within the meaning of
38 U.S.C.A. § 5107(a). That is, we hold that he has
presented a claim which is plausible. As well, we are
satisfied, following a review of the record, that all
relevant facts have been properly developed and that no
useful purpose would be served by again remanding the case
to the RO with directions to provide further assistance to
the veteran. In this regard, we note that considerable data
have been added to the record since this case was previously
before BVA in May 1991. Moreover, there has been no showing
on the veteran's part that medical examinations performed by
VA in the recent past were inadequate or otherwise
productive of findings which do not adequately reflect the
nature and severity of the disorders. We find that the
evidence currently of record is sufficient for fair and
equitable disposition of the instant appeal, and as such, VA
is found to have no further obligation to assist the veteran
in the development of facts pertinent to this claim.
38 U.S.C.A. § 5107(a).
Some of the basic facts are not in dispute. Service
connection has been established for various disorders, to
include peripheral vascular insufficiency of the left lower
extremity, evaluated as 20 percent disabling; bilateral pes
planus, evaluated as noncompensable; a dysthymic disorder,
evaluated as noncompensable; bilateral hearing loss,
evaluated as noncompensable; and impotency, evaluated as
noncompensable. The veteran has also been found to be
entitled to special monthly compensation under 38 U.S.C.A.
§ 1114(k) (West 1991) and 38 C.F.R. § 3.350(a) (1992) for
loss of use of a creative organ. Facts which remain in
dispute will be discussed below.
Service connection connotes many factors, but basically it
means that the facts, as shown by the evidence, establish
that a particular injury or disease resulting in disability
was incurred coincident with service, or if preexisting such
service, was aggravated therein. 38 U.S.C.A. §§ 1110,
1131; 38 C.F.R. § 3.303(a). Certain chronic diseases, such
as arthritis and cardiovascular disease, to include
hypertension, shall be presumed to have been incurred in
service, where a veteran served continuously for ninety
(90) days or more during a period of war or during peacetime
service after December 31, 1946, and such diseases become
manifest to a degree of 10 percent or more within one year
from the date of termination of such service. 38 U.S.C.A.
§§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309.
I. Right Shoulder
Service medical records are wholly negative for complaints
or findings involving the right shoulder. We note, in this
regard, that the veteran specifically denied the presence of
shoulder pain at the time of his retirement medical
examination in March 1989. The initial complaint of
soreness of the right shoulder was made known by the veteran
at the time of a VA orthopedic examination in August 1989,
at which time no abnormality of the right shoulder was
present on either clinical or radiological evaluation. It
is also evident that the veteran has not tied his right
shoulder disorder to any trauma experienced by him either in
service or at some other point in time. Notwithstanding the
contentions of the veteran to the contrary, which we note
remain undocumented, the record does not demonstrate that
there has ever been present a disorder of the veteran's
right shoulder. We therefore must deny the veteran's claim
of entitlement to service connection for a right shoulder
disorder. 38 U.S.C.A. §§ 1110, 1131, 5107(b); 38 C.F.R.
§ 3.303.
II. Arthritis, Left Foot
Service medical records show that X-rays of the veteran's
left foot, taken in April 1974, were within normal limits.
Immediately prior thereto, the veteran sustained a sprain of
the left ankle while playing baseball. In April 1980, the
veteran's complaint's of foot problems were found to be
associated with his pes planus and right foot osteophyte
formation. Complaints of left foot pain, which were set
forth by the veteran in November 1983, were attributed to
the veteran's pes planus. X-rays of both ankles in November
1983 identified spur formation arising from the posterior
aspects of the right and left calcaneus. Beginning in
September 1988, the veteran complained of swelling of the
left great toe of several days' duration. A prior medical
history of elevated levels of uric acid was set forth, and
an assessment of rule out gouty arthritis was entered. In
this connection, it is noted that uric acid levels of the
veteran ranged from a low of 6.8 milligrams in September
1988 to a high of 8.9 milligrams in January 1980. A
diagnosis of gouty arthritis was not confirmed during the
remainder of the veteran's period of military service or at
any point during post service years.
After service, the veteran was initially examined by VA
during 1989, when he reported that he had lost two days of
work because of swelling of the left foot. Orthopedic
examination of the left foot was entirely normal from a
clinical standpoint, and radiographs of the left foot were
found to be normal. The examining orthopedist entered a
pertinent diagnosis of no evidence of arthritis of the left
foot. A somewhat elevated level of uric acid of
8.4 milligrams was noted, the upper limits of normal being
7.9 milligrams. While there has been shown to be episodic
elevation of uric acid levels for some period of time, the
fact remains that the presence of gouty arthritis or
arthritis due to trauma or some other cause, is not
objectively demonstrated either in service or thereafter.
To this extent, the veteran's contentions with respect to
the service incurrence of arthritis of the left foot remain
uncorroborated, and in the absence of salient evidence
showing that the claimed disorder is of service onset, we
must deny the veteran's claim of entitlement to service
connection for arthritis of the left foot. 38 U.S.C.A.
§§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R.
§§ 3.303, 3.307, 3.309.
III. Cholesterolemia
Hypercholesterolemia, also known as cholesterolemia, is
defined as an excess of cholesterol within the blood.
Dorland's Illustrated Medical Dictionary, 629 (26th ed.
1974). An excess of cholesterol within the veteran's blood
is shown to have been present in service from 1980 to 1989,
but no examining or treating physician, either in service or
thereafter, has to date linked the veteran's cholesterolemia
to any other disorder, to include cardiovascular disease.
In sum, the elevated laboratory value is not representative
of a disease or injury for which service connection may be
granted. 38 U.S.C.A. 1110, 1131; 38 C.F.R. § 3.303.
Accordingly, that portion of the veteran's appeal must also
be denied.
IV. Heart or Cardiovascular Disorder
Evidence of a heart or cardiovascular disorder was absent at
the time of the veteran's enlistment medical examination in
January 1965, and as such, he is entitled to a presumption
of soundness at service entrance with respect to such
disorder. 38 U.S.C.A. §§ 1111, 1137 (West 1991). Service
medical records, beginning in January 1980, evidence
transient elevation of the veteran's blood pressure, with
there being prolonged intervening periods during which his
blood pressure readings were all normal. Indicia of chronic
disability involving hypertension are not in evidence during
service or thereafter, and a diagnosis thereof has never
been made. It is noted that a sustained diastolic blood
pressure of 90 or more millimeters of mercury demonstrates
essential hypertension. Harrison's Principles of Internal
Medicine, 1002 (12th ed. 1991).
The presence of organic heart disease or a cardiovascular
disorder is not otherwise documented in service or during
post service years. Various testing, to include radiographs
of the veteran's chest, electrocardiograms and a graded
exercise treadmill test, performed during the period from
1965 to 1987, were generally negative for any evidence of
heart disease or a cardiovascular disorder. An X-ray film
of the veteran's chest in October 1987 showed that the
veteran's heart appeared to be enlarged, although that
enlargement was attributed to a somewhat shallow inspiration
by the veteran at the time of the chest X-ray. Further
evaluation was thereafter undertaken in November and
December 1987 in light of the existence of multiple
cardiovascular risk factors, to include complaints of
atypical chest pain with exercise, longstanding increased
cholesterol levels, an extended history of tobacco use,
complaints of intermittent claudication of the lower
extremities, and a family history of cerebrovascular and
arteriosclerotic cardiovascular diseases. Preliminary
clinical assessments in December 1987 were of
arteriosclerotic disease, increased cholesterol, tobacco
abuse, intermittent claudication, and chest pain (rule out
angina). Further cardiovascular evaluation later in
December 1987 showed that the veteran's electrocardiogram
was within normal limits and that a graded exercise
treadmill test was also normal. Findings from examination
and testing led to entry of an impression of
arteriosclerotic peripheral vascular disease, secondary to
hyperlipidemia and cigarette usage. It is noteworthy that
service connection has already been established for the
arteriosclerotic process affecting the veteran's peripheral
vascular system.
On the occasion of the veteran's retirement medical
examination in March 1989, he voiced a complaint of pain or
pressure within the chest. He specifically denied
experiencing palpitations or a pounding heart, heart
trouble, or high or low blood pressure. Clinical evaluation
of the veteran's heart was within normal limits, and his
blood pressure was 122/80. His electrocardiogram was
interpreted to be within normal limits. X-ray films of the
veteran's chest showed no active pulmonary disease, but the
heart was found to be enlarged with a cardiothoracic ratio
of 18/32. Despite the X-ray findings obtained in February
1989, X-ray examination of the veteran's chest by VA in
August 1989 identified no enlargement of the heart. The
veteran's electrocardiogram was interpreted to be
borderline; nevertheless, clinical evaluation disclosed no
indicia of organic heart disease or a cardiovascular
disorder. Similarly, examination of the veteran by a VA
cardiologist in August 1991 demonstrated no evidence of
cardiac disease, despite the presence of many cardiac risk
factors. At that time, it was noted that an echocardiogram
in July 1991 had been found to be within normal limits, with
there being no signs of cardiomegaly. An electrocardiogram
in August 1991 was likewise found to be within normal limits.
Inasmuch as recently developed data fail to confirm the
inservice finding of heart enlargement or otherwise
demonstrate the presence of a heart or cardiovascular
disorder of any type, we find that the veteran's contentions
as to the service incurrence of such disorder are not
persuasive. The great weight of the evidence presented is
that the veteran does not now suffer from a heart disorder,
and we thus must also deny his claim of entitlement to
service connection therefor. 38 U.S.C.A. §§ 1101, 1110,
1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.303, 3.307,
3.309.
V. Bilateral Pes Planus
For assignment of a 10 percent schedular evaluation for
bilateral or unilateral pes planus, based on moderate
severity, it must be shown that the weight-bearing line is
over or medial to the great toe, that there is inward bowing
of the tendo achillis and that there is pain on manipulation
and use of the feet. 38 C.F.R. Part 4, Code 5276. For
assignment of a 30 percent schedular evaluation for severe
bilateral pes planus, there must be objective evidence of
marked deformity, pain on manipulation and use accentuated,
an indication of swelling on use, and characteristic
callosities. 38 C.F.R. Part 4, Code 5276.
Service medical records show that the veteran's pes planus
was described as moderate in degree in August 1980 and
November 1987. Orthopedic examination by VA in August 1989
showed that both longitudinal arches were completely
flattened and that the feet were pronated and rotated
externally with mild heel valgus. The plantar fascia was
relaxed; however, there was no tenderness of either foot on
the plantar surface. The diagnosis was of pes planus,
complete, bilateral. On a Compensation and Pension
examination by VA in February 1992, the examiner noted that
the veteran walked with a flat-footed gait and that his feet
were turned outwards somewhat. He was capable of toe and
heel walking. There was noted to be marked depression of
the arches of the feet, thereby indicating the presence of
third degree pes planus. A relevant diagnosis was not
recorded.
Complaints of the veteran with respect to painful feet upon
prolonged standing or walking are noted. His foot-related
pain is not found to be continuous or of such a nature as to
be labeled "severe." While each longitudinal arch is
completely flattened, there is not shown to be marked
deformity of pronation or abduction, nor is there
demonstrated to be characteristic callosities of either
foot. The recent examination identified relaxation of the
plantar fascia, but no tenderness of either foot on the
plantar surface was in evidence. Based on the foregoing, it
is our conclusion that the veteran's bilateral pes planus is
of moderate severity and as such, a schedular evaluation of
10 percent, but none greater, is for assignment.
38 U.S.C.A. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3,
4.7, 4.10, 4.40, 4.57, 4.59 and Part 4, Code 5276. An
exceptional or unusual disability picture involving such
factors as a marked interference with employment or frequent
periods of hospitalization for management of the veteran's
bilateral pes planus is not shown to be present, and in our
view, the 10 percent schedular evaluation assigned
adequately compensates the veteran for the level of
impairment demonstrated. 38 C.F.R. § 3.321(b).
VI. Dysthymic Disorder
For assignment of a compensable schedular evaluation for the
veteran's dysthymic disorder, there must be shown to be
emotional tension or other evidence of anxiety that is
productive of mild social and industrial impairment.
38 C.F.R. Part 4, Code 9405. Where there are neurotic
symptoms which may somewhat adversely affect relationships
with others, but which do not cause impairment of one's
working ability, a noncompensable evaluation is for
assignment. 38 C.F.R. Part 4, Code 9405.
It is noted that the veteran set forth a complaint of
depression on his retirement medical examination in March
1989, although no psychiatric abnormality was found to be in
evidence. He was afforded a VA neuropsychiatric examination
in August 1989, at which time he reported that he was
working two jobs, one as a mechanic and the other as a cab
driver. He reportedly was living with his second wife and
he was unhappy about the fact that two children by his first
marriage had very little to do with him. He described
feelings of frequently being "down in the dumps" and
increasing discouragement. He reportedly was not suicidal
and was not experiencing crying spells. It was indicated
that he had no hobbies. Mental status evaluation showed
that the veteran was in no acute distress, and he was not
anxious, although he appeared mildly depressed. No evidence
of a psychosis or organicity was present. The diagnosis was
of a dysthymic state (neurotic depression), mild. The
examiner recommended that the veteran seek outpatient
medical assistance at a VA facility for his psychiatric
problems, but it is not shown that any medical assistance
was received by the veteran during post service years for
his service-connected dysthymic disorder. All evidence
developed during post service years, to include written
statements submitted to VA by or on behalf of the veteran,
does not confirm that the veteran has lost any time from
various employment activities specifically because of his
service-connected dysthymic disorder. In all, the
manifestations attributable to the disorder in question are
not found to result in an impairment of the veteran's
ability to perform his chosen employment.
It is noteworthy that the examiner's classification of the
veteran's dysthymic disorder as "mild" in August 1989 is not
determinative of the degree of disability, but the
examination report and the analysis of the symptomatology
and full consideration of the whole history by the rating
agency will be. 38 C.F.R. § 4.130. Two of the most
important determinants of disability are time lost from
gainful work and decrease in work efficiency, and in the
absence of evidence to the contrary, we find that the
veteran's dysthymic disorder is not productive of actual
symptomatology resulting in a mild industrial impairment.
Accordingly, a noncompensable schedular evaluation is for
assignment for the disorder in question. 38 U.S.C.A.
§§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10,
4.125, 4.130 and Part 4, Code 9405. Also, an increased
disability evaluation is not warranted on an extraschedular
basis, since no evidence is presented with which to verify
an exceptional or unusual disability picture involving such
factors as a marked interference with employment or frequent
periods of hospitalization. 38 C.F.R. § 3.321(b).
VII. Bilateral Hearing Loss
Evaluations of bilateral defective hearing range from
noncompensable to 100 percent based on organic impairment of
hearing acuity as measured by the results of controlled
speech discrimination tests together with the average
hearing threshold level as measured by pure tone audiometry
tests in the frequencies 1,000, 2,000, 3,000 and
4,000 cycles per second. To evaluate the degree of
disability from bilateral service-connected defective
hearing, the revised rating schedule establishes 11 auditory
acuity levels designated from Level I for essentially normal
acuity through Level VI for profound deafness. 38 C.F.R.
§ 4.85 and Part 4, Codes 6100 to 6110.
In connection with the veteran's claim for increase for
bilateral hearing loss, we note that on an authorized
audiological examination by VA in September 1989, average
pure tone thresholds of 44 and 35 decibels were obtained for
the right and left ears, respectively. Speech
discrimination for both the right and left ears was
96 percent. The findings obtained were felt to be
representative of a moderate to severe high frequency
hearing loss in the right ear and a mild to moderate high
frequency hearing loss in the left ear.
The aforementioned audiometric findings are equivalent to
Level I hearing in both ears, for which a noncompensable
schedular evaluation is for assignment. 38 C.F.R. § 4.85
and Part 4, Code 6100. Despite the veteran's statements to
the contrary, it has not been objectively demonstrated in
this instance that the veteran's hearing impairment is at
such a level as to warrant the assignment of a compensable
schedular evaluation under existing legal criteria.
Moreover, an extraschedular evaluation of increased
disability is not also found to be in order, inasmuch as it
has not been shown that such factors as a marked
interference with employment or frequent periods of
hospitalization result in an exceptional or unusual
disability picture involving bilateral hearing loss.
38 C.F.R. § 3.321(b). We must deny the veteran's claim for
increase for bilateral hearing loss, as the great weight of
the evidence presented does not support the veteran's
assertion that a compensable rating is for assignment.
38 U.S.C.A. §§ 1155, 5107(b).
With respect to all the issues denied in the instant
decision, it is observed that we have considered the
doctrine of affording the veteran the benefit of any
existing doubt with regard to those matters. Nevertheless,
the record, as applicable to each denied issue, is not in
relative equipoise such as would warrant resolution of those
matters in the veteran's favor.
ORDER
Service connection for a right shoulder disorder, arthritis
of the left foot, cholesterolemia and a heart disorder is
denied. Increased (compensable) ratings for a dysthymic
disorder and bilateral hearing loss are denied.
An increased rating to 10 percent for bilateral pes planus
is warranted, subject to those provisions governing the
payment of monetary benefits.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
(MEMBER TEMPORARILY ABSENT) B. KANNEE
ALBERT D. TUTERA
*38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of
Veterans' Appeals Section, upon direction of the Chairman of
the Board, to proceed with the transaction of business
without awaiting assignment of an additional Member to the
Section when the Section is composed of fewer than three
Members due to absence of a Member, vacancy on the Board or
inability of the Member assigned to the Section to serve on
the panel. The Chairman has directed that the Section
proceed with the transaction of business, including the
issuance of decisions, without awaiting the assignment of a
third Member.
(CONTINUED ON NEXT PAGE)
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991), a decision of the Board of Veterans' Appeals granting
less than the complete benefit, or benefits, sought on
appeal is appealable to the United States Court of Veterans
Appeals within 120 days from the date of mailing of notice
of the decision, provided that a Notice of Disagreement
concerning an issue which was before the Board was filed
with the agency of original jurisdiction on or after
November 18, 1988. Veterans' Judicial Review Act, Pub. L.
No. 100-687, § 402 (1988). The date which appears on the
face of this decision constitutes the date of mailing and
the copy of this decision which you have received is your
notice of the action taken on your appeal by the Board of
Veterans' Appeals.